As part of efforts to make health care spending more efficient, the government is forging ahead with a number of digitisation initiatives under the banner of its electronic health, or e-health, programme. The need for such a strategy has been precipitated by a “perfect storm demanding continued transformation in health care”, according to Munir Ismet, HP’s head of cloud business for public sector, health care and education in Europe, the Middle East and Africa, speaking at the Fifth Saudi eHealth Conference in November 2014. He went on to describe a range of contributing factors, including an ageing population, fewer clinicians, escalating costs, government reforms and tech-savvy patients who seek greater empowerment in a world where two-thirds of health spending goes to managing chronic diseases. Saudi Arabia’s ambitious e-health programme will thus require considerable investment, forming a large part of the $551m that GCC states are expected to spend on health care IT services in 2015.
The Ministry of Health (MoH) launched its e-health strategy in 2011, aiming to deliver a “safe, efficient health system, based on care centred on the patient and supported by e-health”. The strategy consists of two five-year phases, including key milestones set for the third, fifth and final years of the plan. The e-health vision comprises more than 70 projects, ranging from quick wins to major multi-year endeavours, such as the roll-out of automated systems at the Kingdom’s 2900-odd primary health care centres. Areas of focus for the coming year will include remote monitoring of patients, automation for pharmacies and data management, Atif Choudhary, marketing development manager at Arabian Health Care Supply, told OBG.
A central element of the e-health programme is the creation of an interoperable electronic health record for all patients, which will be available for doctors to view across the country via a national electronic record system. The system will be integrated with hospitals and primary health care centres, while also linking diagnostic records systems to each other. From a patient’s perspective, this will make it easier to travel and receive medical attention anywhere in the Kingdom, as doctors will have ready access to all the information they need about a patient’s history. Besides helping to reduce costs, the government hopes that such a system will encourage patients to make greater use of the country’s rising number of primary care centres, rather than going straight to the hospital as a first port of call. By freeing up capacity, this, in turn, should help hospitals improve their services.
To ensure the privacy of patient records, only authorised health workers will be able to access these on a need-to-know basis. Additionally, patients will be given the option to further restrict access to sensitive personal data and to review who else has looked at their health information and for what purpose.
Underpinning the system for storing and sharing patients’ electronic health records will be a set of data centres containing servers, storage, and security and privacy protocols necessary for supporting the MoH’s critical business systems. Phased in over several years, the data centres will be connected to each other through a secure, high-performance telecoms network that will eventually be linked to all hospitals, primary health care centres, specialist clinics and MoH offices in the Kingdom. In due course, secure connections will be added for pharmacies, private clinics, ambulances and other health facilities, such as medical facilities used by the Saudi Arabian National Guard.
The creation of a centralised patient record system holds the promise of generating a valuable dataset that could be used in medical and pharmacological research. This, in turn, could boost the medical research sector in the Kingdom and aid policymakers as they seek to design future health policies for the country. Among the datasets that the MoH anticipates being able to collect and analyse in the future as a result of the e-health programme are admissions and demographic data for patients; reports for diagnostic tests, such as pathological and radiological examinations, radiology and other images; medication prescriptions; and records of allergies and immunisations.
The e-health programme is expected to improve the standard of care for chronic patients in particular. According to Accenture, a consultancy, chronic pathologies constitute the largest burden on resources for health care systems around the world – they typically represent 30% of patients but absorb 70-80% of health resources. E-health can help reduce this burden by offering patients a range of services, allowing them to anticipate, control and manage their illnesses through primary care or home care, thereby reducing hospitalisation rates.
One way to achieve this is through predictive health care models that analyse “big data” on patients – which the creation of a national health record system will enable. Such analyses can then be integrated with remote care systems, including call centres and tele-monitoring facilities, to support the delivery of care through telemedicine equipment. Guilherme DeSouza, an associate professor at the University of Missouri, has highlighted the key role that new technology can play in addressing the deficit of nurses and caregivers in health systems around the world. By allowing patients to monitor the progress of their own conditions, e-health empowers them to manage their rehabilitation and perform independently many activities that would otherwise require the assistance of a caregiver.
The Saudi e-health system will bring numerous benefits for the typical patient. It will allow hospital-goers to access health information through multiple channels – the internet, telephone, text messages and booklets – and more easily book appointments online. It should help reduce the confusion that can arise under the present system when patients receive services from different locations, and should shorten lead times for diagnosis. The MoH also expects e-health to bolster patients’ confidence in their providers, making it easier to compare them against national performance statistics. It will enhance patient safety by helping to prevent medical errors such as the simultaneous prescription of incompatible drugs.
The benefits will also extend to health care professionals. Besides giving instant access to their patients’ records, features like automated referrals, the ability to hold teleconsultations with colleagues in other locations, support from systems with built-in intelligence that helps prevent medical errors, and online access to continuous medical education will all aid medical practitioners in performing their duties.
E-health will make health care delivery more efficient. Hospital staff will no longer need to wait for patient scans and diagnostic tests to be processed, or to lose time gathering patient data that has already been captured elsewhere. Under the e-health system, hospitals are already tweaking their X-ray systems to send images automatically to doctors’ computers.
From a management perspective, too, there will be efficiency gains. Health care managers will have access to up-to-date performance indicators, automatically captured at the point of service, which they will then be able to analyse by facility, region or provider to investigate problems and compare their performance against other areas or even countries. Ehealth will also aid planning for the Hajj and Umrah by gathering health information on pilgrims when they apply for visas. The collection of such data by the MoH will allow it to collaborate more effectively with other public health bodies, while cutting waste by flagging duplications in health service delivery.
The MoH recognises that it will face a number of challenges in delivering its e-health vision. Some of these are technical, such as ensuring viable alternatives in the event of a computer system failure, or providing connectivity to facilities in remote areas. Moreover, patients currently have several health records each, holding at least one per provider, contributing to data fragmentation and the duplication of services.
Despite these challenges, the MoH has made steady progress in rolling out e-health across the Kingdom. Among the milestones reached in 2014 were the launches of systems for e-health records, picture archiving, communications, cloud computing, the health electronic surveillance network, neonatal protection, poison control and telemedicine. The MoH also linked most of its hospitals to an electronic system to register and follow up on critical medical errors. The next step as the e-health programme enters its fifth year will be to link private hospitals to the same system.